Notice of Privacy Practices

Karlson Psychotherapy, LLC · Effective October 9, 2026

PLEASE READ THIS CAREFULLY. THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.

This notice applies to the health information created and kept by Karlson Psychotherapy, LLC, and by David Karlson, MA, LMFT. I am required by law to protect the privacy of your health information, to give you this notice of my legal duties and privacy practices, and to follow the terms of the notice currently in effect. Where Minnesota law protects your information more strictly than federal law, I follow Minnesota law. In several of the situations below, that means I will ask for your written consent even where federal law would allow me to proceed without it.

1. HOW I MAY USE AND SHARE YOUR INFORMATION WITHOUT YOUR AUTHORIZATION

Treatment
I use your information to provide and coordinate your care — for example, to plan your treatment, to document our sessions, or, with your consent, to speak with another provider involved in your care.

Payment
I use your information to bill you and to be paid — for example, to prepare an invoice, or to prepare a superbill you have asked for so you can seek reimbursement from your insurer.

Health care operations
I use your information to run the practice — for example, to review my own work, to maintain records, or to consult with other licensed professionals about my clinical work. In consultation I do not share information that identifies you, and those professionals are bound by confidentiality.

Where the law requires or permits disclosure
I may use or share your information without your authorization in these situations:

— When required by law, including by court order or a lawful subpoena.
— Suspected abuse or neglect of a child, or maltreatment of a vulnerable adult. I am a mandated reporter under Minnesota law.
— A serious and specific threat of violence. If you communicate a specific, serious threat of physical violence against an identifiable person, Minnesota law may require me to warn that person, or to notify law enforcement.
— A serious risk of harm to you. I may disclose information in good faith to prevent or lessen a serious threat to your health or safety, including contacting emergency services or your emergency contact.
— Health oversight. To a licensing board or other agency authorized to oversee my practice.
— Business support. To vendors who help me operate the practice — my records system, video platform, and payment processor — each of which is bound by a business associate agreement or equivalent protection.
— Unpaid accounts. If an account is referred for collection, limited information may be shared: your name, contact information, dates of service, and the amount owed. Clinical information is not shared for this purpose.

2. USES THAT ALWAYS REQUIRE YOUR WRITTEN AUTHORIZATION

Some uses of your information always require your written permission. These include:

— Psychotherapy notes. Separate notes I may keep about the content of a session receive special protection and are not released without your specific written authorization, except in the narrow circumstances the law requires.
— Marketing. I will not use your information to market anything to you.
— Sale of your information. I do not and will not sell your information.
— Most disclosures to third parties, including family members, other providers, employers, attorneys, and insurers.

You may revoke an authorization in writing at any time. Revoking it stops any further use or sharing, but it does not undo anything already done in reliance on it.

In couples and family work, the record belongs to everyone who took part. I will not release it, or provide information to a third party, without the written authorization of every adult who participated, except where the law requires disclosure.

3. YOUR RIGHTS

— See and get a copy of your record. Ask in writing. Records are provided within the time Minnesota law requires, and any copying charge will not exceed the maximum Minnesota law allows. In limited circumstances where I believe direct review would harm you, I may provide a summary instead or arrange review with another professional.
— Ask me to correct your record. If you believe something is wrong or incomplete, ask in writing. If I decline, I will tell you why and you may file a statement of disagreement, which becomes part of the record.
— Ask for limits on what I use or share. You may request a restriction. I am not required to agree to every request, but I will tell you either way. One restriction I must honor: if you pay for a service in full yourself, you may tell me not to share information about it with a health plan.
— Ask me to contact you a particular way. For example, only at a certain number, or only by email. I will accommodate reasonable requests without asking why.
— Get a list of certain disclosures. You may request an accounting of disclosures I have made, other than those for treatment, payment, operations, and a few others the law excepts.
— Get a paper copy of this notice, even if you agreed to receive it electronically.
— Be told if your information is breached. If a breach compromises your information, I will notify you as the law requires.
— Choose someone to act for you. A person with legal authority to make health decisions for you may exercise these rights on your behalf. I will confirm that authority before acting on it.

4. MY DUTIES

— I am required by law to protect the privacy and security of your health information.
— I am required to give you this notice and to follow the terms of the notice currently in effect.
— I will not use or share your information other than as described here, unless you give me written permission.
— I may change this notice. A changed notice applies to all information I hold, including information created before the change. The current version is always available on request and is posted at karlsontherapy.com.

5. IF YOU HAVE A CONCERN OR WANT TO COMPLAIN

If you believe your privacy rights have been violated, please tell me — in session, by email at [email protected], or by phone or text at (612) 444-2810. I would rather hear it directly and put it right.

You may also complain to the federal government, with or without talking to me first:

U.S. Department of Health and Human Services, Office for Civil Rights
200 Independence Avenue SW, Washington, DC 20201
Phone 1-877-696-6775 · hhs.gov/hipaa/filing-a-complaint

A complaint must generally be filed within 180 days of when you knew the problem occurred. You will not be penalized, and your care will not be affected, for making a complaint.

6. WHO TO CONTACT

Privacy contact: David Karlson, MA, LMFT
Practice: Karlson Psychotherapy, LLC (Karlson Therapy)
Email: [email protected]
Phone or text: (612) 444-2810
Website: karlsontherapy.com
Effective date of this notice: October 9, 2026